股股转流下胸腹主动脉瘤的外科治疗  

Surgical treatment of thoracoabdominal aortic aneurysm under femoral-femoral bypass

作　　者：胡海瓯[1] 朱俊明[1] 郑铁[1] 乔志钰[1] 里程楠[1] 葛翼鹏[1] 唐兵 方卫纲 刘永民[1] 孙立忠 HU Hai-ou;ZHU Jun-ming;ZHENG Tie;QIAO Zhi-yu;LI Cheng-nan;GE Yi-peng;TANG Bin;FANG Wei-gang;LIU Yong-min;SUN Li-zhong(Cardiac surgery department,Beijing Anzhen Hospital affiliated to Capital Medical University,Beijing Institute of heart lung and blood vessel disease,Beijing 100029,China;Internal medicine department,Jiahui International Hospital,Shang Hai 200030,China;Cardiac surgery department,Delta Health Hospital,Shanghai 201702,China)

机构地区：[1]首都医科大学附属北京安贞医院心外科北京市心肺血管疾病研究所,北京市100029 [2]上海嘉会国际医院内科 [3]上海德达医院心脏大血管外科

出　　处：《中国心血管病研究》2023年第5期385-389,共5页Chinese Journal of Cardiovascular Research

基　　金：国家自然科学基金(81970393、81900490);北京市科技计划项目(Z191100006619093、Z191100006619094)。

摘　　要：目的总结股股转流下胸腹主动脉瘤的外科治疗经验。方法回顾性分析首都医科大学附属北京安贞医院2013年2月至2020年10月期间,在股股转流体外氧合下行胸腹主动脉替换患者资料,并对这组患者的术前、术中及术后的临床资料进行总结分析。结果股股转流下胸腹主动脉替换术患者共137例,病理类型包括CrawfordⅠ型19例(13.9%),CrawfordⅡ型66例(48.2%),CrawfordⅢ型36例(26.3%),CrawfordⅣ型16例(11.7%)。手术死亡2例(1.5%),术后30天死亡10例(7.3%)。术后急性肾功能衰竭需要连续肾脏替代疗法(CRRT)治疗患者20例(14.6%),呼吸功能衰竭二次插管11例(8.0%);截瘫10例(7.3%),其中迟发性截瘫6例(4.4%)。137例患者中深低温停循环下手术31例,术后无截瘫发生。结论股股转流下行胸腹主动脉替换术,术中能够对阻断远端各脏器提供有效保护,同时,在股股转流情况下能够降低近端主动脉游离的难度,保障手术顺利进行,尤其适合在刚开始开展胸腹主动脉替换手术的单位和近端主动脉游离困难的患者中推广应用。Objective To summarize the surgical treatment experience of thoracoabdominal aortic aneurysm under femoral-femoral bypass.Methods A retrospective analysis was conducted on the data of the patients undergoing thoracoabdominal aortic replacement under femoral-femoral bypass in our hospital from February 2013 to October 2020.The preoperative,intraoperative and postoperative clinical data of the patients were summarized and analyzed.Results A total of 137 patients underwent thoracoabdominal aortic replacement under femoral-femoral bypass,with pathological types including CrawfordⅠtype in 19 cases(13.9%),CrawfordⅡtype in 66 cases(48.2%),CrawfordⅢtype in 36 cases(26.3%)and CrawfordⅣtype in 16 cases(11.7%).There were 2 surgical deaths(1.5%)and 10 deaths(7.3%)30 days after surgery.Postoperative acute renal failure required continuous renal replacement therapy(CRRT)in 20 patients(14.6%)and secondary intubation in 11 patients(8.0%)with respiratory failure;there were 10 cases of paraplegia(7.3%),including 6 cases of delayed paraplegia(4.4%).Among 137 patients,31 underwent surgery under deep hypothermic circulatory arrest and no paraplegia occurred after the surgery.Conclusion Thoracoabdominal aortic replacement under femoral-femoral bypass can provide effective protection for organ ischemia during the surgery.At the same time,it can reduce the difficulty of proximal aortic dissociation and ensure the smooth progress of the surgery.It is particularly suitable for the units that have just started thoracoabdominal aortic replacement and patients with difficulty in proximal aortic dissociation.

关 键 词：胸腹主动脉瘤 股股转流 胸腹主动脉替换术 连续肾脏替代疗法 截瘫 

分 类 号：R654.7[医药卫生—外科学]